Management of Massive Hemorrhage during Endoscopic Sinus Surgery

Stankiewicz reviewed the complications of endoscopic intranasal ethmoidectomy in 1987l and updated his reported in 1989.' In his initial article five cases of significant hemorrhage occurred, with two patients losing more than 1200 ml of blood during surgery. His subsequent report listed no major hemorrhages. Freedman and Kern3 and Maniglia et aL4 have reported on complication rates, but a report of internal carotid injury, with massive hemorrhage and survival, has not yet been reported. Traumatic intraoperative carotid artery injury requires emergent management with a sequential plan after control of the hemorrhage. This case reports the successful management of this complication so that other endoscopic sinus surgeons might gain experience with this rare and life-threatening complication.